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Walker MT, Bloodworth JC, Kountz TS, McCarty SL, Green JE, Ferrie RP, Campbell JA, Averill SH, Beckman KB, Grammer LC, Eng C, Avila PC, Farber HJ, Rodriguez-Cintron W, Rodriguez-Santana JR, Serebrisky D, Thyne SM, Seibold MA, Burchard EG, Kumar R, Cook-Mills JM. 5-HTP inhibits eosinophilia via intracellular endothelial 5-HTRs; SNPs in 5-HTRs associate with asthmatic lung function. FRONTIERS IN ALLERGY 2024; 5:1385168. [PMID: 38845678 PMCID: PMC11153829 DOI: 10.3389/falgy.2024.1385168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
Background Previous research showed that 5-hydroxytryptophan (5HTP), a metabolic precursor of serotonin, reduces allergic lung inflammation by inhibiting eosinophil migration across endothelial monolayers. Objective It is unknown if serotonin receptors are involved in mediating this 5HTP function or if serotonin receptor (HTR) single nucleotide polymorphisms (SNPs) associate with lung function in humans. Methods Serotonin receptor subtypes were assessed by qPCR, western blot, confocal microscopy, pharmacological inhibitors and siRNA knockdown. HTR SNPs were assessed in two cohorts. Results Pharmacological inhibition or siRNA knockdown of the serotonin receptors HTR1A or HTR1B in endothelial cells abrogated the inhibitory effects of 5HTP on eosinophil transendothelial migration. In contrast, eosinophil transendothelial migration was not inhibited by siRNA knockdown of HTR1A or HTR1B in eosinophils. Surprisingly, these HTRs were intracellular in endothelial cells and an extracellular supplementation with serotonin did not inhibit eosinophil transendothelial migration. This is consistent with the inability of serotonin to cross membranes, the lack of selective serotonin reuptake receptors on endothelial cells, and the studies showing minimal impact of selective serotonin reuptake inhibitors on asthma. To extend our HTR studies to humans with asthma, we examined the CHIRAH and GALA cohorts for HTR SNPs that affect HTR function or are associated with behavior disorders. A polygenic index of SNPs in HTRs was associated with lower lung function in asthmatics. Conclusions Serotonin receptors mediate 5HTP inhibition of transendothelial migration and HTR SNPs associate with lower lung function. These results may serve to aid in design of novel interventions for allergic inflammation.
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Affiliation(s)
- Matthew T. Walker
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jeffrey C. Bloodworth
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Timothy S. Kountz
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Samantha L. McCarty
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jeremy E. Green
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ryan P. Ferrie
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jackson A. Campbell
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Samantha H. Averill
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | | | - Leslie C. Grammer
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Pedro C. Avila
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Harold J. Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, United States
| | | | | | - Denise Serebrisky
- Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY, United States
| | - Shannon M. Thyne
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Max A. Seibold
- Center for Genes, Environment, and Health and the Department of Pediatrics, National Jewish Health, Denver, CO, United States
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Denver, CO, United States
| | - Esteban G. Burchard
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Rajesh Kumar
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Allergy and Clinical Immunology, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Joan M. Cook-Mills
- Allergy-Immunology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, United States
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Alqahtani F, Alruwaili AH, Alasmari MS, Almazroa SA, Alsuhaibani KS, Rasool MF, Alruwaili AF, Alsanea S. A Physiologically Based Pharmacokinetic Model to Predict Systemic Ondansetron Concentration in Liver Cirrhosis Patients. Pharmaceuticals (Basel) 2023; 16:1693. [PMID: 38139819 PMCID: PMC10747545 DOI: 10.3390/ph16121693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Ondansetron is a drug that is routinely prescribed for the management of nausea and vomiting associated with cancer, radiation therapy, and surgical operations. It is mainly metabolized in the liver, and it might accumulate in patients with hepatic impairment and lead to unwanted adverse events. METHODS A physiologically based pharmacokinetic (PBPK) model was developed to predict the exposure of ondansetron in healthy and liver cirrhosis populations. The population-based PBPK simulator PK-Sim was utilized for simulating ondansetron exposure in healthy and liver cirrhosis populations. RESULTS The developed model successfully described the pharmacokinetics of ondansetron in healthy and liver cirrhosis populations. The predicted area under the curve, maximum systemic concentration, and clearance were within the allowed twofold range. The exposure of ondansetron in the population of Child-Pugh class C has doubled in comparison to Child-Pugh class A. The dose has to be adjusted for liver cirrhosis patients to ensure comparable exposure to a healthy population. CONCLUSION In this study, the developed PBPK model has described the pharmacokinetics of ondansetron successfully. The PBPK model has been successfully evaluated to be used as a tool for dose adjustments in liver cirrhosis patients.
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Affiliation(s)
- Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (A.H.A.); (S.A.A.); (K.S.A.)
| | - Abdullah H. Alruwaili
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (A.H.A.); (S.A.A.); (K.S.A.)
| | - Mohammed S. Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (A.H.A.); (S.A.A.); (K.S.A.)
| | - Sultan A. Almazroa
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (A.H.A.); (S.A.A.); (K.S.A.)
| | - Khaled S. Alsuhaibani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (A.H.A.); (S.A.A.); (K.S.A.)
| | - Muhammad F. Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Abdulkarim F. Alruwaili
- Clinical Pharmacy Unit, Department of Pharmaceutical Services, Dallah Hospital, Riyadh 12381, Saudi Arabia;
| | - Sary Alsanea
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (A.H.A.); (S.A.A.); (K.S.A.)
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Coppola P, Kerwash E, Cole S. Use of Physiologically Based Pharmacokinetic Modeling for Hepatically Cleared Drugs in Pregnancy: Regulatory Perspective. J Clin Pharmacol 2023; 63 Suppl 1:S62-S80. [PMID: 37317504 DOI: 10.1002/jcph.2266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/18/2023] [Indexed: 06/16/2023]
Abstract
Physiologically based pharmacokinetic modeling could be used to predict changes in exposure during pregnancy and possibly inform medicine use in pregnancy in situations in which there is currently limited or no available clinical PK data. The Medicines and Healthcare Product Regulatory Agency has been evaluating the available models for a number of medicines cleared by hepatic clearance mechanisms. Models were evaluated for metoprolol, tacrolimus, clindamycin, ondansetron, phenytoin, caffeine, fluoxetine, clozapine, carbamazepine, metronidazole, and paracetamol. The hepatic metabolism through cytochrome P450 (CYP) contributes significantly to the elimination of these drugs, and available knowledge of CYP changes during pregnancy has been implemented in the existing pregnancy physiology models. In general, models were able to capture trends in exposure changes in pregnancy to some extent, but the magnitude of pharmacokinetic change for these hepatically cleared drugs was not captured in each case, nor were models always able to capture overall exposure in the populations. A thorough evaluation was hampered by the lack of clinical data for drugs cleared by a specific clearance pathway. The limited clinical data, as well as complex elimination pathways involving CYPs, uridine 5'-diphospho-glucuronosyltransferase and active transporter for many drugs, currently limit the confidence in the prospective use of the models. Pregnancy-related changes in uridine 5'-diphospho-glucuronosyltransferase and transport functions are emerging, and incorporation of such changes in current physiologically based pharmacokinetic modeling software is in progress. Filling this gap is expected to further enhance predictive performance of models and increase the confidence in predicting PK changes in pregnant women for hepatically cleared drugs.
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Affiliation(s)
- Paola Coppola
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Essam Kerwash
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Susan Cole
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
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Peltz G, Jansson LM, Adeniyi-Jones S, Cohane C, Drover D, Shafer S, Wang M, Wu M, Govindaswami B, Jegatheesan P, Argani C, Khan S, Kraft WK. Ondansetron to reduce neonatal opioid withdrawal severity a randomized clinical trial. J Perinatol 2023; 43:271-276. [PMID: 36030327 PMCID: PMC9968817 DOI: 10.1038/s41372-022-01487-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if treatment with a 5-HT3 antagonist (ondansetron) reduces need for opioid therapy in infants at risk for neonatal opioid withdrawal syndrome (NOWS). STUDY DESIGN A multicenter, randomized, placebo controlled, double blind clinical trial of ninety (90) infants. The intervention arms were intravenous ondansetron or placebo during labor followed by a daily dose of ondansetron or placebo in infants for five days. RESULTS Twenty-two (49%) ondansetron-treated and 26 (63%) placebo-treated infants required pharmacologic treatment (p > 0.05). The Finnegan score was lower in the ondansetron-treated group (4.6 vs. 5.6, p = 0.02). A non-significant trend was noted for the duration of hospitalization. There was no difference in need for phenobarbital or clonidine therapy, or total dose of morphine in the first 15 days of NOWS treatment. CONCLUSIONS Ondansetron treatment reduced the severity of NOWS symptoms; and there was an indication that it could reduce the length of stay. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01965704.
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Affiliation(s)
- Gary Peltz
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Lauren M Jansson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Adeniyi-Jones
- Department of Pediatrics Nemours Neonatology at Jefferson, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol Cohane
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David Drover
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven Shafer
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Meiyue Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Manhong Wu
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Balaji Govindaswami
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Cynthia Argani
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salwa Khan
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Walter K Kraft
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
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Wu M, Cheng Z, Le AT, Tan Y, Peltz G. Optimizing a therapy for opiate use disorders: Characterizing ondansetron pharmacokinetics in blood and brain. Clin Transl Sci 2022; 16:216-223. [PMID: 36305236 PMCID: PMC9926069 DOI: 10.1111/cts.13440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/30/2022] Open
Abstract
Administration of a widely used 5-hydroxytryptamine receptor (5HT3A R) antagonist (ondansetron) potently inhibited the development of experimentally induced opioid dependence and withdrawal responses in mice and humans. However, in several studies examining withdrawal symptoms in subjects with chronic opioid use disorders (OUDs), ondansetron exhibited reduced or absent efficacy. Because attenuation of opioid withdrawal symptomatology is mediated within the brain, this study examined single-dose ondansetron pharmacokinetics in the blood and brain of mice. We demonstrate that ondansetron concentrations in the brain (Cbrain ng/mg) are 1000-fold lower than the blood concentrations (Cblood ng/ml) and decrease rapidly after ondansetron administration; and that a large percentage of brain ondansetron remains in the ventricular fluid. These results indicate that the ondansetron dose, and the time window between ondansetron and opioid administration, and when withdrawal is assessed are critical considerations for clinical studies involving subjects with chronic OUD. The pharmacokinetic results and the dosing considerations discussed here can be used to improve the design of subsequent clinical trials, which will test whether a more prolonged period of ondansetron administration can provide a desperately needed therapy that can prevent the development of neonatal opioid withdrawal syndrome in babies born to mothers with chronic OUD.
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Affiliation(s)
- Manhong Wu
- Department of Anesthesia, Pain, and Perioperative MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Zhuanfen Cheng
- Department of Anesthesia, Pain, and Perioperative MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Anthony T. Le
- Department of PathologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Yalun Tan
- Department of Anesthesia, Pain, and Perioperative MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Gary Peltz
- Department of Anesthesia, Pain, and Perioperative MedicineStanford University School of MedicineStanfordCaliforniaUSA
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Job KM, Dallmann A, Parry S, Saade G, Haas DM, Hughes B, Berens P, Chen JY, Fu C, Humphrey K, Hornik C, Balevic S, Zimmerman K, Watt K. Development of a Generic Physiologically-Based Pharmacokinetic Model for Lactation and Prediction of Maternal and Infant Exposure to Ondansetron via Breast Milk. Clin Pharmacol Ther 2022; 111:1111-1120. [PMID: 35076931 PMCID: PMC10267851 DOI: 10.1002/cpt.2530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 11/11/2022]
Abstract
Ondansetron is commonly used in breastfeeding mothers to treat nausea and vomiting. There is limited information in humans regarding safety of ondansetron exposure to nursing infants and no adequate study looking at ondansetron pharmacokinetics during lactation. We developed a generic physiologically-based pharmacokinetic lactation model for small molecule drugs and applied this model to predict ondansetron transfer into breast milk and characterize infant exposure. Drug-specific model inputs were parameterized using data from the literature. Population-specific inputs were derived from a previously conducted systematic literature review of anatomic and physiologic changes in postpartum women. Model predictions were evaluated using ondansetron plasma and breast milk concentration data collected prospectively from 78 women in the Commonly Used Drugs During Lactation and infant Exposure (CUDDLE) study. The final model predicted breast milk and plasma exposures following a single 4 mg dose of intravenous ondansetron in 1,000 simulated women who were 2 days postpartum. Model predictions showed good agreement with observed data. Breast milk median prediction error (MPE) was 18.4% and median absolute prediction error (MAPE) was 53.0%. Plasma MPE was 32.5% and MAPE was 43.2%. The model-predicted daily and relative infant doses were 0.005 mg/kg/day and 3.0%, respectively. This model adequately predicted ondansetron passage into breast milk. The calculated low relative infant dose indicates that mothers receiving ondansetron can safely breastfeed. The model building blocks and population database are open-source and can be adapted to other drugs.
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Affiliation(s)
- Kathleen M. Job
- Division of Clinical Pharmacology, Department of Pediatrics, The University of Utah, Salt Lake City, Utah, USA
| | - André Dallmann
- Pharmacometrics/Modeling & Simulation, Research & Development, Bayer AG, Leverkusen, Germany
| | - Samuel Parry
- Division of Maternal-Fetal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Saade
- University of Texas Medical Branch–Galveston, Galveston, Texas, USA
| | - David M. Haas
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brenna Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Pamela Berens
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Jia-Yu Chen
- The Emmes Company, LLC, Rockville, Maryland, USA
| | - Christina Fu
- The Emmes Company, LLC, Rockville, Maryland, USA
| | | | - Christoph Hornik
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Stephen Balevic
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Kanecia Zimmerman
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Kevin Watt
- Division of Clinical Pharmacology, Department of Pediatrics, The University of Utah, Salt Lake City, Utah, USA
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Peltz G, Tan Y. What Have We Learned (or Expect to) From Analysis of Murine Genetic Models Related to Substance Use Disorders? Front Psychiatry 2022; 12:793961. [PMID: 35095607 PMCID: PMC8790171 DOI: 10.3389/fpsyt.2021.793961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022] Open
Abstract
The tremendous public health problem created by substance use disorders (SUDs) presents a major opportunity for mouse genetics. Inbred mouse strains exhibit substantial and heritable differences in their responses to drugs of abuse (DOA) and in many of the behaviors associated with susceptibility to SUD. Therefore, genetic discoveries emerging from analysis of murine genetic models can provide critically needed insight into the neurobiological effects of DOA, and they can reveal how genetic factors affect susceptibility drug addiction. There are already indications, emerging from our prior analyses of murine genetic models of responses related to SUDs that mouse genetic models of SUD can provide actionable information, which can lead to new approaches for alleviating SUDs. Lastly, we consider the features of murine genetic models that enable causative genetic factors to be successfully identified; and the methodologies that facilitate genetic discovery.
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Affiliation(s)
- Gary Peltz
- Department of Anesthesia, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, United States
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George M, Ipe S, Ipe S, Abraham S. Spinal anesthesia for elective cesarean section – Comparison of levobupivacaine and ropivacaine with hyperbaric racemic bupivacaine. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liu XI, Green DJ, van den Anker JN, Rakhmanina NY, Ahmadzia HK, Momper JD, Park K, Burckart GJ, Dallmann A. Mechanistic Modeling of Placental Drug Transfer in Humans: How Do Differences in Maternal/Fetal Fraction of Unbound Drug and Placental Influx/Efflux Transfer Rates Affect Fetal Pharmacokinetics? Front Pediatr 2021; 9:723006. [PMID: 34733804 PMCID: PMC8559552 DOI: 10.3389/fped.2021.723006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/13/2021] [Indexed: 01/16/2023] Open
Abstract
Background: While physiologically based pharmacokinetic (PBPK) models generally predict pharmacokinetics in pregnant women successfully, the confidence in predicting fetal pharmacokinetics is limited because many parameters affecting placental drug transfer have not been mechanistically accounted for. Objectives: The objectives of this study were to implement different maternal and fetal unbound drug fractions in a PBPK framework; to predict fetal pharmacokinetics of eight drugs in the third trimester; and to quantitatively investigate how alterations in various model parameters affect predicted fetal pharmacokinetics. Methods: The ordinary differential equations of previously developed pregnancy PBPK models for eight drugs (acyclovir, cefuroxime, diazepam, dolutegravir, emtricitabine, metronidazole, ondansetron, and raltegravir) were amended to account for different unbound drug fractions in mother and fetus. Local sensitivity analyses were conducted for various parameters relevant to placental drug transfer, including influx/efflux transfer clearances across the apical and basolateral membrane of the trophoblasts. Results: For the highly-protein bound drugs diazepam, dolutegravir and ondansetron, the lower fraction unbound in the fetus vs. mother affected predicted pharmacokinetics in the umbilical vein by ≥10%. Metronidazole displayed blood flow-limited distribution across the placenta. For all drugs, umbilical vein concentrations were highly sensitive to changes in the apical influx/efflux transfer clearance ratio. Additionally, transfer clearance across the basolateral membrane was a critical parameter for cefuroxime and ondansetron. Conclusion: In healthy pregnancies, differential protein binding characteristics in mother and fetus give rise to minor differences in maternal-fetal drug exposure. Further studies are needed to differentiate passive and active transfer processes across the apical and basolateral trophoblast membrane.
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Affiliation(s)
- Xiaomei I. Liu
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, United States
| | - Dionna J. Green
- Office of Pediatric Therapeutics, Office of the Commissioner, US Food and Drug Administration, Silver Spring, MD, United States
| | - John N. van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, United States
| | - Natella Y. Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, United States
- Technical Strategies and Innovation, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States
| | - Homa K. Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States
| | - Jeremiah D. Momper
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Kyunghun Park
- Office of Clinical Pharmacology, US Food and Drug Administration, Silver Spring, MD, United States
| | - Gilbert J. Burckart
- Office of Clinical Pharmacology, US Food and Drug Administration, Silver Spring, MD, United States
| | - André Dallmann
- Pharmacometrics/Modeling and Simulation, Research and Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
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Sahin S, Calapoglu F, Ozbek Yazici S, Ozmen I. Investigation of binding interaction behavior between antiemetic drugs and Trypsin by spectroscopy and molecular docking. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2021; 258:119817. [PMID: 33901946 DOI: 10.1016/j.saa.2021.119817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Antiemetic drugs are used to control excessive vomiting and nausea and generally absorbed through gastrointestinal tract. In present study, the in-vitro binding interactions two of the antiemetic drugs (dimenhydrinate and ondansetron) between Trypsin (Tsn) secreted from pancreas to small intestine for protein digestion were investigated by fluorescence emission spectroscopy (FES), UV-VIS spectroscopy, synchronous fluorescence spectroscopy (SFS), FT-IR spectroscopy and molecular modeling methods. Also, the effect of these drugs on the catalytic activity of Tsn was determined. The fluorescence quenching experiments indicated that each drugs quenched the intrinsic fluorescence of Tsn with their increased concentrations. The results of SFS and UV-VIS spectra proved the interaction of dimenhydrinate and ondansetron with Tsn. FT-IR spectra showed that the secondary structure of enzyme was altered in the presence of the drugs. All these spectroscopy results were validated and explained by molecular docking studies. Both drugs have inhibition effect on the catalytic activity of Tsn and the IC50 values were determined as 2.6 × 10-4 M and 6.4 × 10-4 M for dimenhydrinate and ondansetron, respectively. Docking results revealed that the hydrogen bond interaction of dimenhydrinate with active-site residue Ser195 and ondansetron with active-site residues His57 and Ser195 hydrogen bonds might be cause the inhibition of enzyme activity. The results of this study can provide valuable information in the field of pharmacokinetics and pharmacodynamics.
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Affiliation(s)
- Selmihan Sahin
- Faculty of Arts and Sciences, Department of Chemistry, Suleyman Demirel University, Cunur, Isparta 32260, Turkey.
| | - Furkan Calapoglu
- Faculty of Arts and Sciences, Department of Chemistry, Suleyman Demirel University, Cunur, Isparta 32260, Turkey
| | - Sercan Ozbek Yazici
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Burdur Mehmet Akif Ersoy University, Istiklal Yerleskesi, Burdur 15100, Turkey
| | - Ismail Ozmen
- Faculty of Arts and Sciences, Department of Chemistry, Suleyman Demirel University, Cunur, Isparta 32260, Turkey
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Assessing the impacts on fetal dosimetry of the modelling of the placental transfers of xenobiotics in a pregnancy physiologically based pharmacokinetic model. Toxicol Appl Pharmacol 2020; 409:115318. [PMID: 33160985 DOI: 10.1016/j.taap.2020.115318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
The developmental origin of health and diseases theory supports the critical role of the fetal exposure to children's health. We developed a physiologically based pharmacokinetic model for human pregnancy (pPBPK) to simulate the maternal and fetal dosimetry throughout pregnancy. Four models of the placental exchanges of chemicals were assessed on ten chemicals for which maternal and fetal data were available. These models were calibrated using non-animal methods: in vitro (InV) or ex vivo (ExV) data, a semi-empirical relationship (SE), or the limitation by the placental perfusion (PL). They did not impact the maternal pharmacokinetics but provided different profiles in the fetus. The PL and InV models performed well even if the PL model overpredicted the fetal exposure for some substances. The SE and ExV models showed the lowest global performance and the SE model a tendency to underprediction. The comparison of the profiles showed that the PL model predicted an increase in the fetal exposure with the pregnancy age, whereas the ExV model predicted a decrease. For the SE and InV models, a small decrease was predicted during the second trimester. All models but the ExV one, presented the highest fetal exposure at the end of the third trimester. Global sensitivity analyses highlighted the predominant influence of the placental transfers on the fetal exposure, as well as the metabolic clearance and the fraction unbound. Finally, the four transfer models could be considered depending on the framework of the use of the pPBPK model and the availability of data or resources to inform their parametrization.
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Fugetto F, Filice E, Biagi C, Pierantoni L, Gori D, Lanari M. Single-dose of ondansetron for vomiting in children and adolescents with acute gastroenteritis-an updated systematic review and meta-analysis. Eur J Pediatr 2020; 179:1007-1016. [PMID: 32382791 DOI: 10.1007/s00431-020-03653-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
This review aimed to meta-analyze evidence of efficacy and safety of one single dose of ondansetron for vomiting in children and adolescents with acute gastroenteritis. Database searches of MEDLINE (PubMed), Scopus (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov up to November 2019 were performed. Only randomized clinical trials versus placebo were considered. Fixed and random effect models were used for the analyses of pooled data. Thirteen randomized clinical trials (2146 patients) were finally included. One single dose of ondansetron showed to produce (1) higher chance of vomiting cessation within 8 h (RR 1.41, 95% CI 1.19-1.68; low-quality evidence); (2) lower chances of oral rehydration therapy failure (RR 0.43, 95% CI 0.34-0.55; high-quality evidence), intravenous hydration needs (RR 0.44, 95% CI 0.34-0.57; high-quality evidence), and hospitalization rates within 8 h (RR 0.49, 95% CI 0.32-0.75; high-quality evidence); and (3) no statistically significant differences in return visits to emergency department (RR 1.14, 95% CI 0.74-1.76; high-quality evidence) compared with placebo. Further studies are necessary to better assess long term efficacy and safety of ondansetron in this context.Conclusions: Mixed evidence was found via few studies about the efficacy and safety of a single dose of ondansetron in the pediatric population.What is known:• Ondansetron use for vomiting in pediatric acute gastroenteritis is increasing worldwide.• Actual convictions come from studies evaluating one and more than one dose of the drug.What is new:• This is the first review to collect data about the effects of one single dose of ondansetron on strong and temporally homogeneous clinical outcomes.• This study supports the use of one dose of ondansetron in pediatric acute gastroenteritis.• Further studies are necessary to assess its long-term efficacy and safety.
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Affiliation(s)
- Francesco Fugetto
- Department of Medical and Surgical Sciences (DIMEC), Pediatric Emergency Unit, St. Orsola Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Emanuele Filice
- Department of Medical and Surgical Sciences (DIMEC), Pediatric Emergency Unit, St. Orsola Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy.
| | - Carlotta Biagi
- Department of Medical and Surgical Sciences (DIMEC), Pediatric Emergency Unit, St. Orsola Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Luca Pierantoni
- Department of Medical and Surgical Sciences (DIMEC), Pediatric Emergency Unit, St. Orsola Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, via San Giacomo 12, 40128, Bologna, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences (DIMEC), Pediatric Emergency Unit, St. Orsola Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy
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Elkomy MH. Changing the Drug Delivery System: Does It Add to Non-Compliance Ramifications Control? A Simulation Study on the Pharmacokinetics and Pharmacodynamics of Atypical Antipsychotic Drug. Pharmaceutics 2020; 12:pharmaceutics12040297. [PMID: 32218187 PMCID: PMC7238021 DOI: 10.3390/pharmaceutics12040297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022] Open
Abstract
This study investigates the pharmacokinetic (PK) and pharmacodynamic (PD) consequences of shifting from Quetiapine fumarate immediate-release (IR) to extended-release (XR) formulation in non-adherent schizophrenia patients. Monte-Carlo simulations using population PK and PD models were implemented to predict the time course of plasma concentration and Brief Psychiatric Rating Scale (BPRS) scores following the oral administration of 200 mg Seroquel® every 12 h and 400 mg Seroquel XR® every 24 h in patients experiencing dose delay, omission or doubling. Parameters were computed and their distributions were compared using the Kolmogorov–Smirnov test. Dose irregularities with both formulations had different effects on plasma concentration and %reduction in BPRS scores from baseline. However, the odds ratio of getting a %reduction in BPRS below 14%, or plasma concentration exceeding 500 µg/L, were comparable for adherent and non-adherent patients. Plasma therapeutic concentration after treatment cessation was maintained for <24 h in 48% and 29.6% of patients, and a steady state recovery time of <48 h was achieved in 51% and 13.4% of patients on the IR and XR formulations, respectively. Monte-Carlo simulations predict that the risks associated with the IR dose irregularities are not worsened when the XR formulation is used instead. Non-adherence events involving a single dose of either formulation do not require rescue doses.
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Affiliation(s)
- Mohammed H. Elkomy
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka 42421, Saudi Arabia; ; Tel.: +966-560967705
- Department of Pharmaceutics and Industrial Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
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PharmGKB summary: Ondansetron and tropisetron pathways, pharmacokinetics and pharmacodynamics. Pharmacogenet Genomics 2020; 29:91-97. [PMID: 30672837 DOI: 10.1097/fpc.0000000000000369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Rajawat GS, Belubbi T, Nagarsenker MS, Abrahamsson B, Cristofoletti R, Groot DW, Langguth P, Parr A, Polli JE, Mehta M, Shah VP, Tajiri T, Dressman J. Biowaiver Monograph for Immediate-Release Solid Oral Dosage Forms: Ondansetron. J Pharm Sci 2019; 108:3157-3168. [DOI: 10.1016/j.xphs.2019.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 11/29/2022]
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Dallmann A, Ince I, Coboeken K, Eissing T, Hempel G. A Physiologically Based Pharmacokinetic Model for Pregnant Women to Predict the Pharmacokinetics of Drugs Metabolized Via Several Enzymatic Pathways. Clin Pharmacokinet 2019; 57:749-768. [PMID: 28924743 DOI: 10.1007/s40262-017-0594-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Physiologically based pharmacokinetic modeling is considered a valuable tool for predicting pharmacokinetic changes in pregnancy to subsequently guide in-vivo pharmacokinetic trials in pregnant women. The objective of this study was to extend and verify a previously developed physiologically based pharmacokinetic model for pregnant women for the prediction of pharmacokinetics of drugs metabolized via several cytochrome P450 enzymes. METHODS Quantitative information on gestation-specific changes in enzyme activity available in the literature was incorporated in a pregnancy physiologically based pharmacokinetic model and the pharmacokinetics of eight drugs metabolized via one or multiple cytochrome P450 enzymes was predicted. The tested drugs were caffeine, midazolam, nifedipine, metoprolol, ondansetron, granisetron, diazepam, and metronidazole. Pharmacokinetic predictions were evaluated by comparison with in-vivo pharmacokinetic data obtained from the literature. RESULTS The pregnancy physiologically based pharmacokinetic model successfully predicted the pharmacokinetics of all tested drugs. The observed pregnancy-induced pharmacokinetic changes were qualitatively and quantitatively reasonably well predicted for all drugs. Ninety-seven percent of the mean plasma concentrations predicted in pregnant women fell within a twofold error range and 63% within a 1.25-fold error range. For all drugs, the predicted area under the concentration-time curve was within a 1.25-fold error range. CONCLUSION The presented pregnancy physiologically based pharmacokinetic model can quantitatively predict the pharmacokinetics of drugs that are metabolized via one or multiple cytochrome P450 enzymes by integrating prior knowledge of the pregnancy-related effect on these enzymes. This pregnancy physiologically based pharmacokinetic model may thus be used to identify potential exposure changes in pregnant women a priori and to eventually support informed decision making when clinical trials are designed in this special population.
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Affiliation(s)
- André Dallmann
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, Westfälische Wilhelms-University Münster, 48149, Münster, Germany.
| | - Ibrahim Ince
- Clinical Pharmacometrics, Bayer AG, 51368, Leverkusen, Germany
| | - Katrin Coboeken
- Clinical Pharmacometrics, Bayer AG, 51368, Leverkusen, Germany
| | - Thomas Eissing
- Clinical Pharmacometrics, Bayer AG, 51368, Leverkusen, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, Westfälische Wilhelms-University Münster, 48149, Münster, Germany
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Yun YE, Edginton AN. Model qualification of the PK-Sim® pediatric module for pediatric exposure assessment of CYP450 metabolized compounds. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:789-814. [PMID: 31405354 DOI: 10.1080/15287394.2019.1652215] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pediatric physiologically based pharmacokinetic (PBPK) models facilitate the estimation of pharmacokinetic (PK) parameters in children under specific exposure conditions. In human health risk assessment, PBPK modeling has been used to determine a chemical-specific human kinetic adjustment factor (HKAF). Due to increased demands in regulatory assessment, model evaluation and qualification have gained growing attention. The aim of this study was to undertake model qualification of pediatric PBPK models for compounds that are primarily metabolized by cytochrome P450 (CYP) enzymes. The objectives were to determine the appropriateness of the virtual individual creating algorithm in PK-Sim® in predicting PK parameters and their variability in children and identify critical system-specific inputs. PBPK models in adults were constructed for several pharmaceuticals (grouped by major clearance process such as CYP3A4). Several age groups of virtual individuals were created to represent children in pediatric clinical studies. The mean and variance of clearance (CL) from virtual populations were compared to observed values. Sensitivity analysis on area under the curve (AUC) was performed. System-specific parameters of virtual children that contribute to inter-individual PK properties were assessed. Eighty-one percent of the comparisons between simulated and observed clearance values were within twofold error. The mean fold errors were 1.1, 1, 0.7 and 1.8 in adolescents, children, infants and neonates, respectively. CL variability was reasonably predicted for 70% of the comparisons with comparable coefficients of variation between observed and predicted. The sensitivity analysis revealed that fraction unbound in plasma, parameters related to CYP enzyme-mediated metabolism and liver volumewere most important in the estimation of pediatric exposure. A comparison of variabilities in weight, height and liver volume in virtual children showed reliable agreement with observed data. The presented results of predictive performance and properties of virtual populations provide confidence in the use of PK-Sim for pediatric PBPK modeling in toxicological applications including PBPK-based-HKAF derivation.
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Affiliation(s)
- Yejin Esther Yun
- School of Pharmacy, University of Waterloo , Waterloo , Ontario , Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo , Waterloo , Ontario , Canada
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Danielsson B, Webster WS, Ritchie HE. Ondansetron and teratogenicity in rats: Evidence for a mechanism mediated via embryonic hERG blockade. Reprod Toxicol 2018; 81:237-245. [PMID: 30149139 DOI: 10.1016/j.reprotox.2018.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 01/02/2023]
Abstract
The potent hERG channel blocking drug ondansetron is used off-label for treatment of nausea and vomiting in early pregnancy. Some human epidemiological studies have associated ondansetron with fetal cardiovascular defects and orofacial clefts. This study investigated the effects of ondanestron on embryonic heart rhythm of gestational day (GD) 13 rat embryos in vitro and then integrated the results with published animal teratology, and animal and human pharmacokinetic studies to perform a risk evaluation. Ondansetron caused concentration dependent bradycardia and arrhythmia. Cardiovascular malformations in rats occurred at exposures slightly higher than those in early human pregnancy. Together the results suggest that ondansetron can have teratogenic potential in rats and humans mediated via hERG block and severe heart rhythm disturbances in the embryo. The risk may be increased in human pregnancy if additional risk factors are present such as hypokalemia.
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Affiliation(s)
- B Danielsson
- Swedish National Board of Health and Welfare, Stockholm, Sweden.
| | - William S Webster
- Discipline of Anatomy and Histology, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Helen E Ritchie
- Discipline of Biomedical Sciences, Sydney Medical School, The Unvieristy of Sydney, Sydney, NSW 2006, Australia.
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Abstract
BACKGROUND Women are commonly prescribed a variety of medications during pregnancy. As most organ systems are affected by the substantial anatomical and physiological changes that occur during pregnancy, it is expected that pharmacokinetics (PK) (absorption, distribution, metabolism, and excretion of drugs) would also be affected in ways that may necessitate changes in dosing schedules. The objective of this study was to systematically identify existing clinically relevant evidence on PK changes during pregnancy. METHODS AND FINDINGS Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Ovid), and Web of Science (Thomson Reuters), from database inception to August 31, 2015. An update of the search from September 1, 2015, to May 20, 2016, was performed, and relevant data were added to the present review. No language or date restrictions were applied. All publications of clinical PK studies involving a group of pregnant women with a comparison to nonpregnant participants or nonpregnant population data were eligible to be included in this review. A total of 198 studies involving 121 different medications fulfilled the inclusion criteria. In these studies, commonly investigated drug classes included antiretrovirals (54 studies), antiepileptic drugs (27 studies), antibiotics (23 studies), antimalarial drugs (22 studies), and cardiovascular drugs (17 studies). Overall, pregnancy-associated changes in PK parameters were often observed as consistent findings among many studies, particularly enhanced drug elimination and decreased exposure to total drugs (bound and unbound to plasma proteins) at a given dose. However, associated alterations in clinical responses and outcomes, or lack thereof, remain largely unknown. CONCLUSION This systematic review of pregnancy-associated PK changes identifies a significant gap between the accumulating knowledge of PK changes in pregnant women and our understanding of their clinical impact for both mother and fetus. It is essential for clinicians to be aware of these unique pregnancy-related changes in PK, and to critically examine their clinical implications.
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Oberdick J, Ling Y, Phelps MA, Yudovich MS, Schilling K, Sadee W. Preferential Delivery of an Opioid Antagonist to the Fetal Brain in Pregnant Mice. J Pharmacol Exp Ther 2016; 358:22-30. [PMID: 27189967 DOI: 10.1124/jpet.115.231902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/27/2016] [Indexed: 02/01/2023] Open
Abstract
Prolonged fetal exposure to opioids results in neonatal abstinence syndrome (NAS), a major medical problem requiring intensive care and increased hospitalization times for newborns with NAS. Multiple strategies are currently available to alleviate withdrawal in infants with NAS. To prevent NAS caused by opioid maintenance programs in pregnant women, blocking fetal dependence without compromising the mother's opiate therapy is desirable. Here we tested in pregnant mice whether a peripherally selective opioid antagonist can preferentially enter the fetal brain and, thereby, in principle, selectively protect the fetus. We show using mass spectrometry that 6β-naltrexol, a neutral opioid antagonist with very limited ability to cross the blood-brain barrier (BBB), readily crosses the placental barrier and enters the fetal brain at high levels, although it is relatively excluded from the maternal brain. Furthermore, owing to the late development of the BBB in postnatal mice, we show that 6β-naltrexol can readily enter the juvenile mouse brain until at least postnatal day 14. Taking advantage of this observation, we show that long-term exposure to morphine starting in the second postnatal week causes robust and quantifiable dependence behaviors that are suppressed by concomitant administration of 6β-naltrexol with much greater potency (ID50 0.022-0.044 mg/kg, or 1/500 the applied dose of morphine) than previously demonstrated for either the suppression of central nervous system opioid effects or the induction of withdrawal in adults. These results indicate that peripherally selective opioid antagonists capable of penetrating the placenta may be beneficial for preventing or reducing neonatal dependence and NAS in a dose range that should not interfere with maternal opioid maintenance.
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Affiliation(s)
- John Oberdick
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Yonghua Ling
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Mitch A Phelps
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Max S Yudovich
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Karl Schilling
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Wolfgang Sadee
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
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Abstract
Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. Although the cornerstone of prenatal management of opioid dependence is opioid maintenance therapy, the ideal agent has yet to be definitively established. Pharmacologic management of NAS is also highly variable and may include an opioid, barbiturate, and/or α-agonist. Genetic factors appear to be associated with the incidence and severity of NAS. Establishing pharmacogenetic risk factors for the development of NAS has the potential for creating opportunities for "personalized genomic medicine" and novel, individualized therapeutic interventions.
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Ansari J, Carvalho B, Shafer SL, Flood P. Pharmacokinetics and Pharmacodynamics of Drugs Commonly Used in Pregnancy and Parturition. Anesth Analg 2016; 122:786-804. [DOI: 10.1213/ane.0000000000001143] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Wachman EM, Schiff DM. Bringing attention to a need for a standardized treatment and weaning protocol for neonatal abstinence syndrome. Transl Pediatr 2016; 5:12-5. [PMID: 26835401 PMCID: PMC4729044 DOI: 10.3978/j.issn.2224-4336.2015.12.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA
| | - Davida M Schiff
- Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA
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